LSJ Employees, LLC
Mailing Address St. Thomas. VI 00802-1348
General contact information Tel:
E-mail:
Accounts payable department contact information Fax:
Vacation / Leave Form
Name: Thomas J Melnick
Date of Request 5/11/12
Dates ofRequested:
Date of First Day of Vacation: June 8th 2012 Date Return to Work: July 2nd 2012
Total Number of Days:
Leave Days: 16 Weekend Days: 8 Holidays: Personal / Sick: Days Remaing: 0 days
Type ofLeave:
07 Vacation with Pay C' Leave without pay r Personal Sick Leave r Other
If Other Explain:
List ofall contact information:
Phone:
Cell:
Email:
The following must be verified with Estate Manager
1. The number of vacation days you have taken.
2. The number employee in your division / department that are leave at the same time
Approved:
EFTA00593602